Quick answer: Dialectical behavior therapy (DBT) teaches skills for handling strong feelings, distress, and relationship problems. These skills may support addiction treatment. A DBT skills group and a complete DBT program offer different levels of support.
At Alpine Recovery Lodge, we tailor our addiction recovery programs to each patient’s needs.
We understand that the causes that contribute to addiction are as individual as our patients. Treatment planning should consider each person’s needs, strengths, substance use, and mental health.
We use many different forms of therapy and treatment to help our patients overcome addiction. Our treatments combine individual therapy, family therapy, and group therapy with other tools to help patients regain a sense of independence and control.
One form of therapy that we have found to be particularly helpful in the treatment of addiction is dialectical behavior therapy, or DBT.
You may be unfamiliar with DBT, but here are five things you need to know about it and how it relates to addiction.
#1: Dialectical Behavior Therapy Works on the Patient’s Reactions to Difficult Situations
Dialectical behavior therapy combines acceptance and change. It helps people understand emotions and practice responses that fit their goals, rather than expecting them to stop having difficult thoughts or feelings.
DBT was developed for people with borderline personality disorder (BPD). Having addiction does not mean a person has BPD. A qualified clinician can assess each condition.
DBT teaches ways to notice feelings, tolerate distress, and choose safer responses. The aim is not to erase emotions or blame the person for having them. It is to practice skills that support daily life.
Substance use can cause serious harm. Its purpose and risks should be assessed individually; it should not be assumed to have the same intent as self-injury.
Through discussion, skills practice, and role-playing, people can build other ways to respond to stress and urges. These skills can support a broader addiction treatment plan, but they do not guarantee that relapse will never happen.
#2: Dialectical Behavior Therapy Uses a Combination of Group and Individual Therapy
Some forms of therapy are specifically carried out in a one-on-one therapeutic relationship between the therapist and the patient. Others focus on therapeutic care in a group setting.
Comprehensive DBT typically combines individual therapy, skills groups, between-session coaching, and a therapist consultation team. A program that teaches DBT skills may not provide this full model. Ask what is included.
- Individual therapy sessions tend to focus on problem-solving techniques. Patients look at issues that arose since their last therapy session and talk about coping mechanisms and what they can do to deal with similar situations in the future. They may also talk about how to improve self-esteem and reduce post-traumatic stress to improve their quality of life.
- Skills groups teach four main areas. Session length depends on the program:
- Interpersonal effectiveness
- Stress tolerance and acceptance of reality
- Regulation of emotions
- Mindfulness skills
Both the individual and the group sessions of dialectical behavior therapy are geared toward helping the patients solve problems and learn how to cope with what may be recognized as extreme emotional reactions.
Regular attendance and practice are part of comprehensive DBT. Discuss barriers to individual or group therapy with the clinician so the plan is realistic and accessible.
Dialectical behavior therapy requires a significant time commitment on the part of the patient. That may mean that the patient’s loved ones have to accommodate their schedule to make time for therapy. Support can help, but people can engage in treatment without family participation. Ask about scheduling, accessibility, and support between appointments.
#3: DBT Uses Mindfulness Without Requiring Religious Beliefs
Mindfulness has roots in contemplative traditions, but DBT is a form of psychotherapy. You do not need to follow a religion to use it.
In DBT, mindfulness means noticing what is happening now without immediately judging it or acting on it. You can notice an emotion, name it, and consider your next step. This is different from suppressing or splitting off feelings.
- Notice thoughts and feelings as they arise.
- Name the emotion: “I feel worried,” or “I feel angry.”
- Recognize that an urge does not require immediate action.
- Choose a response that fits your safety and recovery goals.
A brief practice could be to feel your feet on the floor and describe three things you can see. If focusing inward feels distressing, stop and ask your therapist for another approach. Mindfulness is one skill, not a replacement for treatment.
#4: Dialectical Behavior Therapy Uses Role Playing to Teach New Behavior
For some people, relationship stress or strong emotions are linked with substance use. Others experience different patterns. Role-play should address the person’s actual goals and be voluntary.
A return to substance use can have many causes, including stress, cravings, health concerns, and gaps in support. Practicing responses before a stressful moment can be one part of prevention.
One way that dialectical behavior therapy helps patients learn to cope is by using role-playing. Role-playing involves the therapist – or occasionally, another patient in a group session – playing the role of a significant person in the patient’s life.
The goal of role-playing is to let the patient act out their typical behavior and then examine it to learn better ways of dealing with stressful situations.
For example, a patient who had an antagonistic relationship with her sister might role-play a typical interaction with a therapy group.
The therapist can help her notice both her feelings and the facts. She might practice saying, “I want to talk, but I need us to speak calmly. Let’s take a break and try again.”
The exercise should not assume that mistreatment is imagined or that the person caused it. If a relationship is unsafe, safety and boundaries come first.
In some cases, it might be instructive for somebody else to play the patient’s role and for the patient herself to take the role of her loved one. Either way, role-playing is an important part of dialectical behavior therapy.
#5: DBT Can Address Patterns That Keep Substance Use Going
DBT can help people examine what happens before and after an urge or a return to substance use. This can include a trigger, thoughts, emotions, actions, and consequences.
Understanding a pattern can help a person and clinician plan changes. Addiction has many contributing factors, so no single therapy can be assumed to uncover or resolve every cause.
A clinician can help a person identify relevant triggers and emotional responses, then choose one manageable skill to practice. Relationship work may be useful when it fits the person’s goals; discussing every relationship or disclosing trauma is not a prerequisite for getting support.
The work may include the activities below, adapted to the person’s needs:
- Role playing with the patient playing himself as well as significant people in his life.
- Mindfulness practice to notice emotions without immediate self-judgment.
- Practical self-care and distress-tolerance skills adapted to the person’s needs.
- Identifying emotional triggers and coming up with ways to avoid and/or cope with them.
The process of going through dialectical behavior therapy can be a deeply profound and sometimes unsettling experience. Tell the treatment team about self-injury, thoughts of suicide, or changes in substance use so they can assess safety and support needs. Thoughts of suicide and self-injury are not the same thing. Immediate danger requires emergency help.
Over time, dialectical behavior therapy can help patients get a deep understanding of their addictive behavior so that they can cope with it in the future.
Conclusion
Therapy can be an important part of addiction treatment. The right approach depends on a clinical assessment, the person’s goals, and their response to care.
For patients who have struggled with extreme emotional reactions, dialectical behavior therapy may be the right choice on an ongoing basis. Ask a clinician whether comprehensive DBT, a DBT skills group, or another therapy fits your needs.
Questions to Ask About DBT
- Do you provide comprehensive DBT or use DBT skills within another treatment plan?
- What DBT training do the treating clinicians have?
- How are substance use, mental health, and safety needs assessed?
- What practice and support are available between sessions?
- How will we track whether this approach is helping?
Frequently Asked Questions
Is DBT only for borderline personality disorder?
DBT was developed for borderline personality disorder. DBT approaches and skills are also used in other care settings. Ask a qualified clinician whether they fit your needs.
Does attending a DBT skills group mean I am in full DBT?
No. Skills groups are one component. Ask whether the program also includes individual DBT, coaching between sessions, and a therapist consultation team.
Do I need to practice outside sessions?
Usually, yes. Your clinician may help you choose a skill to try in daily life and review what happened at the next visit.
Ask About Treatment Options at Alpine
Alpine Recovery Lodge serves adults in Alpine, Utah. Talk with admissions about available therapies, an assessment, and the level of care that may fit your needs.